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BMJ Glob Health. 2019 Sep 12;4(5):e001669. doi: 10.1136/bmjgh-2019-001669. eCollection 2019.

Use of standardised patients for healthcare quality research in low- and middle-income countries.

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School of Public Health, University of California Berkeley, Berkeley, California, USA.
McCourt School of Public Policy and School of Foreign Service, Georgetown University, Washington, District of Columbia, USA.
ACCESS Health International, New York City, New York, USA.
Department of Anthropology, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Epidemiology & Biostatistics, and McGill International TB Centre, McGill University, Montreal, Quebec, Canada.
Center for Policy Research, Delhi, India.


The use of standardised patients (SPs)-people recruited from the local community to present the same case to multiple providers in a blinded fashion-is increasingly used to measure the quality of care in low-income and middle-income countries. Encouraged by the growing interest in the SP method, and based on our experience of conducting SP studies, we present a conceptual framework for research designs and surveys that use this methodology. We accompany the conceptual framework with specific examples, drawn from our experience with SP studies in low-income and middle-income contexts, including China, India, Kenya and South Africa, to highlight the versatility of the method and illustrate the ongoing challenges. A toolkit and manual for implementing SP studies is included as a companion piece in the online supplement.


health care providers; quality of care; standardized patients

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